Timing of appropriate antibiotics in patients with septic shock: A retrospective cohort study

Objective: The objective of the present study was to describe the factors associated with delays in the delivery of appropriate antibiotics to patients admitted to the intensive care unit (ICU) from the ED or wards with septic shock. Methods: All adult patients admitted to the ICU, at a single centre who had presented via the ED within the previous 48 h and who had septic shock were included. Data regarding the cause of sepsis, timing of administration of antibiotics, the appropriateness of antibiotics, results of cultures and features potentially related to delay in the administration of appropriate antibiotics were collected by a single investigator, onto specifically designed data forms. Descriptive statistics and univariate analysis were undertaken to determine the timing of appropriate antibiotics administration. Results: Eighty-nine patients who developed septic shock within 48 h of hospital presentation were admitted to the ICU at Royal North Shore between 2005 and 2008. The median time to administration of antibiotics was 120 min (interquartile range [IQR], 40-225) and the median time to administration of appropriate antibiotics was 188 min (IQR, 65-440 min). Patients who did not have sepsis as their initial diagnosis (90 vs 268 min; P < 0.002), those who waited until investigations were performed (88 vs 320 min; P < 0.001) and younger patients (beta = -5.6; P = 0.04) had longer time delays to receive antibiotic therapy. Patients who were assessed by an emergency physician after developing septic shock were given antibiotics that were appropriate in a median of 20 min (IQR, 10-160 min), those assessed initially by a resident medical officer after developing septic shock in a median of 180 min (IQR, 78-563 min). Conclusions: This retrospective cohort study found that there were significant delays associated with the administration of appropriate antibiotics in patients admitted to the ICU from the ED or the wards with septic shock. Delays were greater in patients who were not seen by an emergency physician, those in whom the diagnosis of sepsis was not considered initially and in those whose therapy was delayed while awaiting the performance of investigations.